In these times of change, we're looking toward the future, welcome to the new look of HPI.
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Member Appeal Form
Online Access / PHI Disclosure Form
Member Authorization to Obtain PHI
Member Authorization to Release PHI
Member ID Card
Download or Order an ID Card
Flexible Spending Account (FSA) & Health Reimbursement Arrangement (HRA)*
FSA Claim form
HRA Claim form
FSA Transit/Parking form
FSA/HRA Direct Deposit form
Member Reimbursement form (you can also submit your request in My Plan)
Fitness Reimbursement form (you can also submit your request in My Plan)
Weight Loss Reimbursement form (you can also submit your request in My Plan)
Provider Medical Claim form
Provider Dental Claim form
Short Term Disability form
*Claim and reimbursement forms may not be applicable to all plans. Be sure to check your benefit details in your summary plan description prior to submitting a claim or reimbursement form.
Some forms on this page are in PDF format and require Adobe Reader to open.
Would you like to:
Download your member ID card?
Log in to My Plan
My Plan Login
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